MEDICARE: DR. MITCHELL SCOTT MEYERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	MD9589	HI

General Provider Information

NPI Number	:	1831187962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL SCOTT MEYERS M.D.

Provider Business Mailing Address
First Line	:	1425 PORTER ST
Second Line	:	USAMRIID (MCMR-UIM-O)
City	:	FORT DETRICK
State	:	MD
Zip	:	21702-9211
Country	:	US
Telephone Number	:	301-619-4996
Fax Number	:	301-619-2511

Provider Business Practice Location Address
First Line	:	1425 PORTER ST
Second Line	:	USAMRIID
City	:	FORT DETRICK
State	:	MD
Zip	:	21702
Country	:	US
Telephone Number	:	301-619-4996
Fax Number	:	301-619-2511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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